TY - JOUR
T1 - Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials
AU - Gallardo-Gómez, Daniel
AU - Del Pozo Cruz, Jesús
AU - Pedder, Hugo
AU - Alfonso-Rosa, Rosa M.
AU - Álvarez-Barbosa, Francisco
AU - Noetel, Michael
AU - Jasper, Unyime
AU - Chastin, Sebastien
AU - Ramos-Munell, Javier
AU - del Pozo Cruz, Borja
N1 - Funding Information:
DG-G is supported by a predoctoral teaching and research fellowship via I+D+i Research Programme of the University of Seville, Spain (PIF20/VI-PPITUS). JdP-C is supported by the Government of Andalusia, Research, Development, and Innovation Programme (PAIDI P20_1181). HP is supported by the UK Medical Research Council (MR/R025223/1) and by the UK National Institute for Health and Social Care Excellence (NICE) via the Bristol Technology Assessment Group and the NICE Technical Support Unit. UJ is supported by a University of Adelaide research scholarship. JR-M is supported by a pre-doctoral teaching and research training fellowship from the Spanish government (FPU20/0067). BdPC is supported by the Government of Andalusia, Research Talent Recruitment Programme (EMERGIA 2020/00158). The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report or decision to submit the article for publication.
PY - 2023/10/4
Y1 - 2023/10/4
N2 - Objective: To identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults. Design: Systematic review and Bayesian model-based network meta-analysis. Data sources: Four databases were searched from inception to 20 June 2022. Eligibility criteria for selecting studies: Randomised controlled trials that assessed the effectiveness of a physical activity-based intervention on at least one functional outcome in people aged ≥50 years hospitalised due to an acute medical condition were included. Pooled effect estimates (ie, standardised mean differences for functional capacity and the ratio of means for adverse events) were calculated using random treatment effects network meta-analysis models. Results: Nineteen studies (3842 participants) met the inclusion criteria. Approximately 100 Metabolic Equivalents of Task per day (METs-min/day) (~40 min/ day of light effort or ~25 min/day of moderate effort activities) was the minimal dose to improve the functional capacity of acute hospitalised older adults (standardised mean difference (SMD)=0.28, 95% credible interval (CrI) 0.01 to 0.55). The optimal dose was estimated at 159 METs-min/day (~70 min/day of light effort or ~40 min/day of moderate effort activities; SMD=0.41, 95% CrI 0.08 to 0.72). Ambulation was deemed the most efficient intervention, and the optimal dose was reached at 143 METs-min/day (~50 min/day of slow-paced walking; SMD=0.76, 95% CrI 0.35 to 1.16), showing a high evidential power (87.68%). The minimal effective ambulation dose was estimated at 74 METs-min/day (~25 min/day of slow-paced walking; SMD=0.25, 95% CrI 0.01 to 0.41). Physical activity interventions resulted in a decrease in the rate of adverse events compared with usual care at discharge (ratio of means=0.96, 95% CrI 0.95 to 0.97; median time 7 days). Conclusions: This meta-analysis yielded low to moderate evidence supporting the use of in-hospital supervised physical activity programmes in acutely hospitalised older adults. As little as ~25 min/day of slow-paced walking is sufficient to improve functional capacity and minimise adverse events in this population.
AB - Objective: To identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults. Design: Systematic review and Bayesian model-based network meta-analysis. Data sources: Four databases were searched from inception to 20 June 2022. Eligibility criteria for selecting studies: Randomised controlled trials that assessed the effectiveness of a physical activity-based intervention on at least one functional outcome in people aged ≥50 years hospitalised due to an acute medical condition were included. Pooled effect estimates (ie, standardised mean differences for functional capacity and the ratio of means for adverse events) were calculated using random treatment effects network meta-analysis models. Results: Nineteen studies (3842 participants) met the inclusion criteria. Approximately 100 Metabolic Equivalents of Task per day (METs-min/day) (~40 min/ day of light effort or ~25 min/day of moderate effort activities) was the minimal dose to improve the functional capacity of acute hospitalised older adults (standardised mean difference (SMD)=0.28, 95% credible interval (CrI) 0.01 to 0.55). The optimal dose was estimated at 159 METs-min/day (~70 min/day of light effort or ~40 min/day of moderate effort activities; SMD=0.41, 95% CrI 0.08 to 0.72). Ambulation was deemed the most efficient intervention, and the optimal dose was reached at 143 METs-min/day (~50 min/day of slow-paced walking; SMD=0.76, 95% CrI 0.35 to 1.16), showing a high evidential power (87.68%). The minimal effective ambulation dose was estimated at 74 METs-min/day (~25 min/day of slow-paced walking; SMD=0.25, 95% CrI 0.01 to 0.41). Physical activity interventions resulted in a decrease in the rate of adverse events compared with usual care at discharge (ratio of means=0.96, 95% CrI 0.95 to 0.97; median time 7 days). Conclusions: This meta-analysis yielded low to moderate evidence supporting the use of in-hospital supervised physical activity programmes in acutely hospitalised older adults. As little as ~25 min/day of slow-paced walking is sufficient to improve functional capacity and minimise adverse events in this population.
U2 - 10.1136/bjsports-2022-106409
DO - 10.1136/bjsports-2022-106409
M3 - Review article
AN - SCOPUS:85168639666
SN - 0306-3674
VL - 57
JO - British Journal of Sports Medicine
JF - British Journal of Sports Medicine
IS - 19
ER -